News 4/20/11

CMS says it paid physicians more than $234 million in Medicare incentive bonuses for the 2009 PQRS  program and an additional $148 million in 2009 e-prescribing incentives. The PQRS bonuses averaged $1,956 per provider and $18,525 per practice, while the average e-prescribing bonus was just over $3,000 per provider and $14,051 per practice. CMS reports that participation in PQRS has grown 50% per year since it first began in 2007.

Practice Fusion hires Paul Willard as VP of marketing and Liz Meyerdirk as senior director of business development. Willard was most recently VP of marketing for Coupons.com; Meyerdirk was associate VP of corporate strategy and business development for MedeAnalytics.

Radiology & Imaging (MA) and Seacoast Radiology (NH) select McKesson’s revenue management solutions for billing and coding. I mentioned Seacoast Radiology a few months after hackers breached one of their servers. The likely culprits were said to be “rogue gamers” looking for bandwidth to play Call of Duty: Black Ops.

AMA rolls out its AMAGINE platform nationwide. The subscription-based offering ranges from $20 per month per physician for e-prescribing to $300 a month for EMR. AMAGINE includes access to over 20 HIT solutions, including Allscripts, CareTracker, QuestCare 360, and NextGen.

Beacon IPA (NY) partners with Sequel Systems to offer its members discounted pricing on SequelMed EMR and PM products.

Patients perceive that the use of EHR increases the quality of care and provides a more accurate health record. Eighty-percent of patients have a positive perception of EHRs, though only 62% of physicians feel the same way. Patients are more concerned about privacy and security (81%) than doctors (62%). Both groups agree that the biggest benefits of EHRS are real-time access to records and  the ability to share information among providers.

Allscripts opens registration for its ACE 2011 conference. This year’s big event is August 29-31 in Nashville. If I am reading their graphic correctly, Allscripts expects its ambulatory EHR clients to outnumber the Sunrise customers by about two to one.

The Missouri HIT Assistance Center selects SuccessEHS as a Group One vetted EHR vendor.

Physician offices are better at retaining RNs than hospitals or health systems, likely because of the better work environment. RNs work an average of 3.3 years at a physician offices before changing jobs, but only 3.1 years at general hospitals. Average compensation is higher in hospitals than physician practices, but offices tend to  offer more stability and better culture.

Odd: Physician’s Computer Company issues a press release chastising payers and clearinghouse partners for their “lack of readiness” to test the new 5010 transaction standards. PCC says it has validated its own readiness with its direct-to-payer connections, but is waiting on more than three dozen carriers and clearinghouse partners to get up to speed. I can’t figure out what PCC has to gain from issuing the release, other than a few ticked off partners.

American Well launches Online Care for Providers, a new service that enables physicians to offer telehealth to patients. The offering includes the ability to conduct two-way video, secure text chats, and phone calls. Encounter records  may then be then download into the provider’s EMR.

Most physicians that are considering hospital employment expect to be paid one to five percent more than they are now. Employed physicians believe doctors should be more involved in executive leadership and hospital management, including service on the board of directors. On the other hand, hospital executives aren’t ready to hand over the keys yet and say they’ll need to find funds in order to pay physicians more. Train wreck, anyone?

E-mail Inga (who is visualizing the weekend a bit early)

News 4/19/11

Anyone attest today? CMS opens its Meaningful Use verification period  Monday, marking the first day hospitals and eligible providers can start their 90-day attestation period. EPs wanting to receive a Medicare incentive check by the end of the year will need to start their attestation period no later than October 1.

Ingenix says that family practice physician Douglas Foreman, DO will be among the first physicians to attest. He uses the Ingenix CareTracker EHR.

Meanwhile, ChartLogic announces that 26 of its customers across 19 states plan to start the attestation process as early as April 18.

Greenway Medical announces the integration of its EHR/PM product PrimeSUITE with Cognify’s Participant Tracking System for monitoring care plan continuums.

A big thank you to the folks at Dodge Communications who forwarded their critique of the AMGA exhibit hall. Brad Dodge gave GE Healthcare’s booth Best in Show and recognized MED3OOO for Best Food (one of my favorite categories). Humana won honors for The Booth Most Likely to Be Confused with a DippinDots Stand. Plenty of other fun categories, should you feel the need to cackle. AMGA, by the way, says about 2,000 people participated in their 20011 conference last week in DC.

Also from AMGA: the percentage of physicians practicing part-time is on the rise. A reported 13% of males and 36% of females work part-time, compared to 7% and 29% in 2005. Results from an AMGA-sponsored survey also found that 83% of medical groups plan to hire more primary care physicians this year; 79% intend to hire specialists.

Thomson Reuters releases Micromedex Drug Interactions, a new iPhone app to monitor drug interactions. The $50 app allows physicians to check up to 50 patient medications simultaneously.

Northern Illinois Physicians for Connectivity names Sage Healthcare a preferred partner.

Healthcare South (MA) signs a three-year, Level 1 application support service agreement with Beacon Partners to support its Allscripts EMR system.

Physicians are five times more likely to own an iPad or similar device than the general population. About 27% of primary care and specialty doctors use some sort of tablet computer.

HealthGrades launches a new Web application that enables physicians and administrators to verify and modify their online information.

MD-IT announces the official release of its MD-IT EMR.

A new report predicts that 75% of providers will use e-prescribing over the next five to six years and that the US e-prescribing market will reach $204.6 million. I assume that means providers will spend $204.6 million a year for e-prescribing, but the press release is a bit unclear and I wasn’t curious enough to pay $4,800 for the full report.

athenahealth CEO Jonathan Bush chats with Peter Johnson of Fox News about curbing Medicare costs. Gotta love Fox’s prominent reminder of the Bush’s family ties.

E-mail Inga.

DOCtalk by Dr. Gregg 4/17/11

Pediatric Tar Pits

Way back in the day when dinosaurs first dreamed of computers to solve their workaday needs, I’ll bet some pterodactyl envisioned that computers would one day actually take the drudgery out of their calculational quandaries and let them focus upon doing the dinosaury things that they really wanted to be doing.

Well, that day is finally, really, honestly here – at least for us dinosaurs who deal with pediatric and neonatal drug and parenteral nutrition. I just enjoyed an hour-long webinar (how often can you say you actually “enjoyed” a webinar?) on the new digital tools that Thomson Reuters has just released: Thomson Reuters Pediatrics and Thomson Reuters Neofax.

Any of you familiar with neonatal care have likely heard of Neofax, a great book – pretty much a “must have” for neonatal care providers – chocked full of drug and nutritional information and complex calculations. It has been updated yearly since 1986 and has grown into a rather thick little paperback tome. (Ugh. Paper.)

Any of you familiar with pediatrics know how frequently drug dosages must be calculated – like virtually every single time on virtually every single child – based upon their specific weight (i.e., weight-based dosing.) And then there’s rounding. Do you round off to the closest milliliter or teaspoon? It’s not as simple as “Take a pill twice a day and call me in two weeks.”

Weight-based dosing rises to new levels of head-scratching complexity when it has to be applied to the multiple components of parenteral feeds (infant formula and TPN).

Many EHRs don’t help with this much. Some do, especially those that really “get” pediatrics, but most either ignore this calculation component, say they have it on the “to do” lists, or do some smaller portion of the process.

What Thomson Reuters has done is not just kick it up a notch; they knocked it into a whole new sphere of computer helpmate-dom. They have provided some heavy duty calculational tools to a robust database of drug monographs (Micromedex) using evidenced-based data to provide one of the best little tools any pediatric or neonatal provider could ever hope for. It is easy to navigate, displays information and alerts cleanly, and has some great tools for incorporation into hospital pharmacies and CPOE processes.

They offer “Basic” versions of each via the Internet which have fewer tools and require a little more end-user input and “Premier” editions which are “Intranet-based” with more bells and whistles and patient-specific capabilities.

The only downsides I have seen are: (a) you can’t get a look at it online without a webinar or a demo; (b) I wasn’t able to get any pricing info yet; and (c) it isn’t the prettiest user interface I’ve ever seen.

Despite these minor issues, it is clean, powerful, easy to understand, full of evidenced-based help, and it will probably knock any pediatrician’s socks off regardless of the GUI. It does just exactly the kind of things computers should do to help us pediatric dinosaurs get on about being better dinosaurs without being mired in antediluvian data and calculation tar pits.

From the tar pits…

“I’ve been drawn into your magnet tar pit trap.” – Kurt Cobain

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 4/14/11

From Kelpie: “Re: the EHR Herd. With regard to the Readers’ Write article posted by Reefdiver, KLAS just published a report focused specifically on how prepared each ambulatory EMR vendor’s clients are for MU. I think it would be very useful to your readers that are looking for some sort of help in ‘thinning out the herd,’ as the article says.” Kelpie is with KLAS and is willing to give providers a free executive summary of the report if they are able to spend 15 minutes participating in KLAS’s research. That sounds like a pretty sweet deal, given the standard provider price is $980. If you are interested, e-mail me and I will forward you Kelpie’s contact information.

The new KLAS report, by the way, finds that nearly 80% of ambulatory care providers are confident they will meet Meaningful Use criteria this year. However, KLAS also notes some significant gaps, including the absence of electronic record sharing for two-thirds of the providers and the lack of clinical decision support rules for almost half the surveyed physicians. Epic and Greenway clients are the most prepared to achieve Meaningful Use.

Nuesoft Technologies launches Nuesoft Mobile, a free app for users of Nuesoft’s NueMD medical billing solution. The app includes charge capture functionality, an appointment viewer, and the ability to attach voice notes and images to patient records.

AMGA starts today in Washington DC. That’s one event I’ve wanted to attend for a number of years, but the timing has never been right. If you are there, I’d love an update and/or photos.

The Montgomery AIDS Outreach (AL) selects SuccessEHS as its PM/EHR solution.

The AMA sends a letter to CMS outlining the federal regulations that physicians find most burdensome. Topping the list are unfunded federal mandates, elimination of Medicare payment for physician consultations, and incompatible and inconsistent quality initiatives.

Epocrates introduces a new mobile drug sampling service, Epocrates Mobile Sample Closet. Pharmaceutical companies will use the service to offer physicians custom samples via their mobile devices.

The Alabama Primary Health Associates (APHCA) partners with Arcadia Solutions, which will provide EHR training and support to APHCA’s 15 community health centers.

Speaking of community health centers, The National Association of Community Health Centers estimates CHCs serve 20 million people each year. That number is expected to double by 2015, in part due to increased funding from ARRA and healthcare reform legislation.

The National Hispanic Medical Association partners with DrFirst to offer its clinical and financial products.

WebChartMD, a transcription workflow provider, integrates its platform with M*Modal’s Speech Understanding technology.

Big Sandy Health Care (KY) receives $255,000 in Meaningful Use incentives from Kentucky Medicaid. Its five community health clinics use Meditab clinical software.

The American College of Surgeons launches an online community to support surgeons practicing in rural areas. The resource will allow remote surgeons to seek advice and collaborate with peers.

Radia (WA) signs a five-year agreement with Zotec Partners to manage the 80-physician practice’s accounts receivables.

After reading this study, I vow never again to apologize for allowing my fashion enthusiasm to occasionally overflow to HIStalk. An Archives of Dermatology-published study by a group of dermatologists finds that 20% of adult patients believe their doctors should wear ties. Furthermore, most patients favor the traditional white coat (the doctor’s “badge of authority.”) And, one third of the patients say their trust in their doctor is influenced by his/her attire. Which is crazier: that patients care what their doctors wear? Or, that doctors actually asked patients for fashion advice?

E-mail Inga.

Readers Write 4/13/11

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

The EHR Herd, Part I: Is Certification a Helpful Credential for EHR Purchasers?
By Reefdiver

Would you buy a refrigerator that hasn’t been certified by UL? Would you buy a cut of meat at the supermarket that lacks the USDA stamp of approval? Would you purchase an automobile if it was not certified as meeting the minimum government standards for safety?

On the other hand, does the UL certification tell you which refrigerator is right for your kitchen or family? Does the USDA stamp tell you whether the skirt steak or the filet mignon is a better fit for the meal you are planning? Does the EPA approval tell whether the Smart Car or the Durango XLT is better for your vehicle needs?

As of today on the ONC site, there are 375 EHR products certified by all of the ATCBs combined for the ambulatory market alone, of which 262 are Complete EHRs. (Note: I started writing this two days ago and both of these numbers have gone up by significant amounts in the interim, with no apparent end in sight).

Does anyone else find it absolutely astonishing that that many products can pass the certification criteria that meets government specifications for allegedly being able to help providers meet Meaningful Use (MU) criteria? And that the number continues to grow each week? How hard can these standards of certification be if every product passes?

More than 30% of law school graduates fail to pass the law boards each year. Series 7 exams for new stockbrokers have a pass rate that is less than 50%. CPA exams are notorious for being difficult to pass, with the national average being about an 85% failure rate. Years ago, more than 50% of the pilot trainees in my military flight training class failed to earn their wings during the 15-month training program – they were washing out right up to the last weeks of training.

Is EHR certification getting to be like passing the UL test? As long as the product doesn’t produce a massive shock, it passes? A urine test must be statistically harder to pass than EHR certification. 

EHR certification is almost becoming a rubber stamp. Shouldn’t there be some failures with this many product applicants? Or, does certification not measure some critical differentiators, like usability? Given the 50% implementation failure rate so commonly quoted, maybe it’s just a demonstrative example that with technology, it’s much easier to certify functionality than it is to certify usability or practice-appropriateness.  

What other industry can you think of where this situation — hundreds of software vendors with government-certified products for one single class of end users, medical practices — is possible? Software for airline reservations? Enterprise software? Financial planning, spreadsheets, word processing, inventory control, hotel management, software for law firms, tax preparation software?  

Most of these huge software segments have no more than a handful of competitive software products. More than 300 certified software products for EHR, with more coming each week. Sure seems like a lot. Will probably lead to consolidation problems later!

Should the herd be thinned out, or is it better to have so many products certified? The number of choices is daunting for providers, like the cereal aisle at the market. It will be hard for the EHR market to support this many vendors, but a free enterprise system can often result in two doctrines that come into juxtaposition: survival of the fittest (vendors) and caveat emptor (providers). Does certification help either party more?

The other half of this delicate equation is the providers and practices. Their role is to pick an EHR and show Meaningful Use. Most vendors guarantee the desired outcome, but what is the fine print saying and are providers aware of it? 

With more than 300 certified products to choose from, how do providers pick one that is really right for their practice and specialty? The advice being given out there is pretty bland and not very useful for decision makers as far as I can see. Big vendors are not necessarily better than small ones. I’ll offer some thoughts on that later in the week in Part II of this, should anyone be interested.

For now, I hope some providers will respond to my comments. I’d love to hear how you feel about all the EHR products that are being certified and how is it helping you to choose whether and if to purchase one. And,  how you are going about finding one that really fits your practice and workflow best.